Seeing ultrasound rarely changes abortion plans: study

NEW YORK (Reuters Health) - NEW YORK (Reuters Health) -
Nearly 99 percent of women went ahead with an abortion after
voluntarily viewing an ultrasound image of the fetus beforehand,
according to a large new U.S. study.

Based on medical records for more than 15,000 women seeking
abortion at Los Angeles Planned Parenthood clinics, researchers
found that only a small fraction of the women changed their
minds after seeing the image.

"This study was motivated in large part by the current
political and popular interest in what role ultrasound viewing
plays in women's decisions about abortion," said one of the
authors, Katrina Kimport at the University of California San
Francisco School of Medicine.

Ten states have enacted laws that require doctors to perform
ultrasounds before abortions, and three of those require the
woman to view the image during the ultrasound. The others
require doctors to offer women the option of viewing it.

A 2011 North Carolina ultrasound law, considered one of the
strictest in the nation, was struck down by a federal judge
earlier this month because it forced doctors to explain the
image while showing it to the patient. The U.S. District Court
held that forced speech to be unconstitutional.

Advocates for ultrasound laws base the requirement on the
idea that showing a woman the image of her fetus might cause her
to have a change of heart about terminating the pregnancy.

Kimport said there's been a lot of discussion about what
effects viewing would have on women who are seeking or
considering abortions, but there was very little research on
what actually happens.

"We were interested in bringing in an empirical perspective
to these conversations," she told Reuters Health.

The researchers reviewed medical records from 15,575 visits
at 19 Planned Parenthood clinics in Los Angeles during 2011.
These facilities routinely perform ultrasounds before abortion
procedures and regularly ask the patients if they want to see
the images. It's also standard practice to ask each patient how
confident she is about her decision to terminate the pregnancy.

Responses to both of these questions are noted in the
patient's electronic medical record, according to the
researchers.

Kimport and her colleagues analyzed those records and found
that most women (85.4 percent) said they were certain they had
made the right decision to have the abortion. A smaller number
(7.4 percent) were classified as having medium or low levels of
certainty about getting the procedure.

Although all of the women included in the study had
ultrasounds, less than half (42.5 percent) chose to see the
image.

A total of 98.8 percent of the planned abortions took place.
Among women who did not view their ultrasounds, 99 percent went
through with the procedure. Among those who did view the images,
98.4 percent of the women had abortions.

The images appeared to have the greatest effect among women
who had expressed low or medium certainty about the procedure.
In that group, those who viewed the ultrasounds were slightly
less likely to go through with the abortion: 95.2 percent did
have the procedure, compared to 97.5 percent of uncertain women
who did not view the ultrasound.

Women who expressed high certainty about their decision
showed no differences, whether or not they had viewed the
ultrasound.

The study team also looked at other factors that might
affect the women's decisions and found that how far along the
pregnancy was turned out to be much more significant than
whether a woman viewed ultrasound images.

Women at 17 to 19 weeks of gestation were almost 20 times as
likely to back out of the abortion compared to women at less
than 9 weeks gestation.

Based on their results, the authors conclude in the journal
Obstetrics and Gynecology that mandatory viewing of ultrasound
images is not likely to significantly influence how many women
get abortions.

Women should be offered the opportunity to view their
ultrasound before an abortion, the authors write, but mandatory
viewing should be avoided.

"I think that when we start moving from a place where it's
about a patient decision to a legal requirement, we're moving
into the space that the literature around health suggests is
going to have negative effects on women's health outcomes,"
Kimport said.

The researchers did not study other possible effects of
viewing, or not viewing, ultrasound images, such as their
emotional impact on the women.

Another unknown is what might happen when women feel forced
to view ultrasounds rather than making the choice to see the
images, the study authors write.

"There's extensive literature looking at a range of
health-related issues that show that when a patient feels they
have made a decision - and they feel engaged in the
decision-making - they have better satisfaction with their care
and better health outcomes," Kimport said.